Long head of biceps transfer to augment Bankart repair in chronic anterior shoulder instability with and without subcritical bone loss: a biomechanical study. Long Head of Biceps Transfer to Augment Bankart Repair on Chronic Anterior Shoulder Instability with and Without Subcritical Bone Loss: A Biomechanical Study.
Citation: Journal of Shoulder & Elbow Surgery. 31(5):1062-1072, 2022 May.PMID: 34808351Institution: MedStar Union Memorial HospitalDepartment: Orthopaedic SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Bone Diseases, Metabolic | *Joint Instability | *Shoulder Dislocation | *Shoulder Joint | Arm | Biomechanical Phenomena | Cadaver | Humans | Joint Instability/su [Surgery] | Range of Motion, Articular/ph [Physiology] | Shoulder | Shoulder Dislocation/su [Surgery] | Shoulder Joint/ph [Physiology] | Shoulder Joint/su [Surgery]Year: 2022Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:2004 - 2007ISSN:- 1058-2746
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 34808351 | Available | 34808351 |
Available online from MWHC library: 1995 - present, Available in print through MWHC library:2004 - 2007
BACKGROUND: Treating recurrent anterior shoulder instability in collision sports, capsule-labrum defects, and bipolar bone loss remains challenging. The study purpose was to investigate the effect of long head of biceps transfer (LHBT) on load-to-dislocation biomechanics in a repetitive serial shoulder dislocation cadaveric model comparing LHBT to the Latarjet and Bankart procedures, first-line treatment for chronic traumatic anterior shoulder instability with and without anterior glenoid bone loss, respectively.
CONCLUSIONS: In a serial dislocation model, LHBT effectively stabilized the glenohumeral joint in a simulated chronic instability scenario, increasing pectoralis major load to dislocate and glenohumeral joint reaction force components at the time of dislocation and restoring relative glenohumeral positioning to close to intact state. Latarjet outperformed LHBT in stabilizing shoulders in the 20% subcritical glenoid bone defect. Copyright (c) 2021. Published by Elsevier Inc.
METHODS: This controlled laboratory study dislocated eight fresh-frozen cadaveric shoulders with different conditions in sequence using a custom test frame. Muscle loading configuration simulated the arm in apprehension position, and biceps loads were 20 N and 40 N for the static glenohumeral position analysis to evaluate the sling effect. Sequential experimental conditions included intact, second and third dislocations, chronic instability, Bankart repair, LHBT, subcritical glenoid bone loss, LHBT, and Latarjet.
RESULTS: Pectoralis major and joint reaction loads to dislocation sequentially decreased with serial dislocations in all specimens, with the lowest value in the subcritical glenoid bone defect condition. In the setting of chronic instability, pectoralis load to dislocation was significantly higher with Bankart repair (P=0.031) and LHBT (P<0.001) to 71% and 85% of intact, respectively. Direct comparison of pectoralis load to dislocation favored LHBT over Bankart repair (p=0.015). In the subcritical defect scenario, LHBT did not significantly increase load to dislocate, and the Latarjet demonstrated higher load to dislocate than LHBT (p<0.001). All three surgical procedures tested significantly increased the angle of horizontal abduction at the time of dislocation and restored glenohumeral position to closer to intact. Doubling the biceps load leveraged the sling effect pulling the humeral head further posterior-superiorly, but this was not enough to overcome the effect of a 20% subcritical glenoid bone defect.
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